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Posted December 1, 2012

Cleft and Craniofacial Program at All Children’s

For parents of a child dealing with cleft lip, cleft palate or any other craniofacial abnormalities, life can instantly plunge into a devastating storm of fear and uncertainty over their young one's future. Nobody understands this better than the renowned medical team at the newly formed All Children's Hospital Cleft Palate and Craniofacial Center.

It is a team that taps the expertise of leading plastic surgeons Dr. Michael Gallant and Dr. Ernesto Ruas, and respected pediatrician Dr. Mary Pavan, a talented trio that has worked together more than a quarter century running the Tampa-St. Petersburg Cleft and Craniofacial Center. They have given countless kids beset with severe cleft and craniofacial issues a chance at a normal life – and given their parents peace of mind.

Dr. Gallant, who practices full-time at All Children's, and Dr. Ruas, who has a private practice, have been performing cleft lip and cleft palate surgeries at ACH for decades. And Dr. Pavan, long affiliated with the University of South Florida, has worked with children impacted by the condition since 1985 and served as president of the Florida Cleft Palate Association.

They are continuing a legacy that began more than 60 years ago with the founding of the Cleft Lip and Palate Team in 1954, believed to be the first cleft palate team in Florida. That tradition continued with their distinguished work at the Tampa-St. Petersburg Cleft and Craniofacial Center – fully approved as a Cleft Palate and a Craniofacial Team by the American Cleft Palate Craniofacial Association, and approved by the Children's Medical Services (CMS) peer review process as one of Florida's four Cleft and Craniofacial Centers.

And now, the experienced group has a home in the Outpatient Care Center (OCC) of All Children's Hospital / Johns Hopkins Medicine in St. Petersburg, where the first clinic was held in October.

"We have a lot of history," said Dr. Ruas. "I think we have pretty good horsepower. Michael Gallant is a Yale University graduate. Mary Pavan comes from Harvard. And I come from Hopkins. And with the entire team combined, I think we have more than 100 years of experience."

The results of their work can be found in amazing before-and-after pictures: snapshots of babies and toddlers who came to them with cleft and craniofacial abnormalities and, by the time they began school, looked like any child you would see at the mall.

One of Dr. Gallant's most precious possessions is a large, brown photo album that contains page after page of such photos of children he has helped through the years with stunning results. The album serves as his primary tool for giving comfort to parents who come to him distraught over their child's condition, caused by their skulls and faces not forming properly.

Like his colleagues, he knows the critical value of the multidisciplinary, team approach to treating children with cleft and craniofacial anomalies. That means having experts on the team in orthodontics, led by charter member Dr. Gerald Francati, speech and language pathology, audiology, nursing, otolaryngology (ear, nose and throat specialists), dentistry, psychology and social work.

"You have to have a team to address the many issues these kids face," stressed Dr. Gallant. "But these children also need to follow certain steps in their care, which have to come in a certain sequence and at a certain time. So the key functions of the team, in addition to just providing care, are to first make sure every child gets everything he or she needs, and second, to be sure there's one treatment plan that includes all aspects of the child's care."

Dr. Ruas' iPad contains countless before-and-after examples of children who have received such comprehensive care, starting with the surgeries he has performed over the years. "Our benchmarks for reconstructive surgery results should be the same as for cosmetic surgery," he said. "Our goal is to make them look normal, so if you saw them in a store, you would never know."

Now this full spectrum of services at the highest level is flourishing under the umbrella of ACH / JHM, which Dr. Pavan credits with providing an enormous amount of important assets to the operation.

"We have incredible support from neonatology, genetics, pulmonology, anesthesia, neurosurgery, the OR and post-operative care and much more," Dr. Pavan said. "The hospital is a wonderful place to provide care for kids who have those complex conditions. Although we have all worked together, we haven't had the administrative and care coordination structure to provide team evaluations in a clinic setting and nursing coordination through the ACH umbrella. Now that is possible."

The impetus for the move to All Children's began two years ago when CMS could no longer provide team care and coordination for patients outside of the CMS network, which provides services for families in need of financial assistance or on Medicaid.

That created a pressing need to help children and families with private insurance, since they were suddenly no longer able to come to team evaluations and have care coordination through the team in CMS. Members of the Tampa-St. Petersburg team began working with ACH-JHM to get hospital support, similar to the three other Cleft and Craniofacial Centers in Florida. Patients in the CMS program continue to receive care coordination and team care through CMS, while patients outside that network can now enjoy the same care at All Children's.

One vital member of the All Children's program is experienced team coordinator Cathy Conley, a veteran nurse and cleft and craniofacial care expert who ran the Cleft and Craniofacial Center for CMS some 15 years – overseeing Tampa, St. Petersburg and Lakeland, with Craniofacial outreach as far north as Brooksville and south to Ft. Myers – and later managed Dr. Ruas' practice.

"She ran it well – in fact, she made it what it was," said Dr. Ruas. "She's the one who keeps us in line. She knows more about clefting than most doctors do.

"She has the experience to talk to parents when they first are faced with a child with a cleft, bond with them and teach them how to feed the child because she's a nurse. She can talk to parent in layman's lingo but also get on the phone and talk to a craniofacial surgeon in Boston and be able to communicate with them in clinical terms. That makes our job so much easier."

Conley knew All Children's was the logical answer to house the standout cleft and craniofacial team: "The surgeries are all done here, and many of the providers who are on the team have connections here. Dr. Pavan, Dr. Ruas and Dr. Gallant – all three – were very instrumental in getting to the right people and convincing them of the need and the benefit both to the hospital and the patient."

The team effort continues full force, to the benefit of all.

"The nice thing about a real team – and that's what this is – the practitioners talk all the time," said Dr. Gallant. "So, for example, I'm sure a week doesn't go by when I don't talk to the speech therapist, oral surgeon, the orthodontist about some child or another. There's a constant communication."

And now, that is taking place under the roof of All Children's.

For more information, or to refer a patient, please call the Cleft Palate Craniofacial Program at 727-767-2930.